title: Challenges to accessing pediatric health care in the Mississippi delta: a survey of emergency department patients seeking nonemergency care.
abstract: BACKGROUND
  Increases in hospital emergency department use have been driven by insured patients with problems accessing primary care services. Access problems are especially pronounced in rural communities with health professional shortages. This qualitative study explored reasons for nonurgent pediatric emergency department use in the Mississippi Delta.
  
  
  METHODS
  Using a community-based participatory research framework, a semistructured survey was administered face-to-face in a hospital emergency department waiting room with parents/caregivers who brought their children. Interviews were done over 144 hours in 2-hour blocks covering regular "business hours" and "after hours" (evenings/weekends). Open-ended items allowed qualitative data to be gathered describing reasons for emergency department use and perceptions of urgency of the visit in the parents'/caregivers' own words.
  
  
  RESULTS
  There were 112 children, with a response rate of 87%. The mean child age was 5.7 years; 52% were male; 95% were African American and 5% white; 80.6% had Medicaid/SCHIP, 7.8% commercial, and 3.9% other insurance; 7.8% were uninsured. Most (88%) had a usual source of pediatric care. Only 24.3% tried to obtain care before emergency department visit; 23.2% said their children required "urgent" care. Mean distance from home to usual source of care was 10 miles. Ten percent cited transportation as a barrier to keeping health care appointments; 5.5% cited insurance or cost. Families who used the emergency department during evening/weekends were significantly more likely to have cited clinic hours of operation as a reason care was not sought previously than were "business hours" users, who emphasized convenience.
  
  
  CONCLUSIONS
  Nonurgent pediatric emergency department use could be reduced by extending clinic hours, adding a walk-in service, and making transportation more available.
authors.affiliation: Children's Health Fund, New York, NY, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Grant
authors.forename: Andres
authors.initials: A
authors.lastname: Ramgoolam
authors.forename: Ryan
authors.initials: R
authors.lastname: Betz
authors.forename: Laura
authors.initials: L
authors.lastname: Ruttner
authors.forename: John J
authors.initials: JJ
authors.lastname: Green
keywords: emergency department; health professional shortage area; rural; transportation; underserved